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1.
J Nurs Adm ; 49(10): 503-508, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31517758

RESUMO

OBJECTIVE: To examine changes in new nurses' competencies across the 1st year of practice. BACKGROUND: Competency assessment is a challenge for nurse residency programs and often focuses on skills checklists and confidence self-reports. The Appraisal of Nursing Practice, an observational rating based on Quality and Safety in Nursing Education standards, was developed to help evaluate an RN residency program. METHODS: Preceptors, nurse educators, and/or unit managers from various units rated new nurse residents. Ratings were compared for 353 nurses at 3 points: within the 1st month in the program (T1), at 5 months (T2), and at month 11 (T3). RESULTS: Competency ratings increased significantly for all subscales from T1 to T2. Ratings continued to increase significantly from T2 to T3, although at a slightly slower rate. Teamwork and evidence-based practice increased the most. CONCLUSIONS: Future studies should explore factors affecting the trajectory in developing nursing competencies within various settings.


Assuntos
Competência Clínica/normas , Avaliação de Desempenho Profissional/normas , Guias como Assunto , Cuidados de Enfermagem/normas , Recursos Humanos de Enfermagem/normas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Estados Unidos
2.
J Grad Med Educ ; 11(4): 430-438, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31440338

RESUMO

Background: Workplace-based assessment (WBA) is critical to graduating competent physicians. Developing assessment tools that combine the needs of faculty, trainees, and governing bodies is challenging but imperative. Entrustable professional activities (EPAs) are emerging as a clinically oriented framework for trainee assessment. Objective: We sought to develop an EPA-based WBA tool for pediatric critical care medicine (PCCM) fellows. The goals of the tool were to promote learning through benchmarking and tracking entrustment. Methods: A single PCCM EPA was iteratively subdivided into observable practice activities (OPAs) based on national and local data. Using a mixed-methods approach following van der Vleuten's conceptual model for assessment tool utility and Messick's unified validity framework, we sought validity evidence for acceptability, content, internal structure, relation to other variables, response process, and consequences. Results: Evidence was gathered after 1 year of use. Items for assessment were based on correlation between the number of times each item was assessed and the frequency professional activity occurred. Phi-coefficient reliability was 0.65. Narrative comments demonstrated all factors influencing trust, identified by current literature, were cited when determining level of entrustment granted. Mean entrustment levels increased significantly between fellow training years (P = .001). Compliance for once- and twice-weekly tool completion was 50% and 100%, respectively. Average time spent completing the assessment was less than 5 minutes. Conclusions: Using an EPA-OPA framework, we demonstrated utility and validity evidence supporting the tool's outcomes. In addition, narrative comments about entrustment decisions provide important insights for the training program to improve individual fellow advancement toward autonomy.


Assuntos
Benchmarking/normas , Competência Clínica/normas , Cuidados Críticos/normas , Avaliação de Desempenho Profissional/normas , Pediatria/educação , Educação Baseada em Competências/normas , Educação de Pós-Graduação em Medicina , Feminino , Humanos , Internato e Residência , Masculino , Reprodutibilidade dos Testes , Local de Trabalho
3.
J Infus Nurs ; 42(4): 197-202, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31283662

RESUMO

In Iran, nurses are responsible for administering parenteral nutrition (PN) to hospitalized patients in intensive care units (ICUs). However, little information is available among nurses in Iran regarding best practices in PN administration. This study evaluates the performance of critical care nurses in Iran in the administration of PN. The performance of 50 nurses in the administration of PN in the ICU was observed 3 times during a 5-month period for a total of 150 observations. A researcher-developed checklist, "Critical Care Nurses' Performance in Parenteral Nutrition Administration," was used for data collection. The total score in this checklist ranged from 0 to 52. Based on the procedural steps in the checklist and whether the steps were performed appropriately, nurses' performance was scored as poor, moderate, or good. The mean score of nurses' performances in PN administration skills was 24.6 ± 2.5. This study found that 46 nurses had moderate skill levels in PN administration, and 3 demonstrated poor skills. Overall, the results indicated that critical care nurses in Iran have poor to moderate PN administration skills.


Assuntos
Lista de Checagem/normas , Enfermagem de Cuidados Críticos/normas , Avaliação de Desempenho Profissional/normas , Nutrição Parenteral/métodos , Adulto , Estado Terminal , Feminino , Humanos , Unidades de Terapia Intensiva , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade
4.
Work ; 63(4): 635-642, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31282454

RESUMO

OBJECTIVE: The purpose of this study was to examine the impact of applying six commonly-used and two proposed resting blood pressure (BP) cut-points to clear individuals for maximal exercise in non-clinical health, wellness, commercial fitness agencies and physically demanding occupation test sites. METHODS: Participants (n = 1670) completed the Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) and had their resting BP measured. Individuals with a BP >160/90 mmHg were further screened for contraindications to exercise using the ePARMed-X+ (www.eparmedx.com), all 1670 were cleared. There were no adverse events during or post exercise. RESULTS: The percentages of participants cleared for each BP cut-point were: <130/80 mmHg (85.3%), <140/90 mmHg (93.4%), <144/90 mmHg (94.6%), <144/94 mmHg (96.3%), <150/100 mmHg (98.6%), <160/90 mmHg (95.6%), <160/94 mmHg (97.8%) and <160/100 mmHg (99.5%). Individuals who would not have been cleared without further screening were significantly older, had a higher BMI, or had a lower maximal oxygen consumption. CONCLUSIONS: Conservative or lower resting BP cut-points currently applied to clear individuals for maximal exercise provide an unnecessary barrier. For individuals categorized as low-to- moderate risk by evidence-based screening tools such as the PAR-Q+ and ePARmed-X+, we recommend a resting BP cut-point of <160/94 mmHg to clear for maximal exercise until sufficient evidence is amassed to support the increase to <160/100 mmHg.


Assuntos
Determinação da Pressão Arterial/normas , Avaliação de Desempenho Profissional/normas , Exercício/fisiologia , Saúde do Trabalhador/normas , Exame Físico/normas , Adulto , Fatores Etários , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Avaliação de Desempenho Profissional/métodos , Feminino , Academias de Ginástica/normas , Humanos , Masculino , Consumo de Oxigênio/fisiologia , Exame Físico/métodos , Padrões de Referência , Descanso/fisiologia , Adulto Jovem
5.
Work ; 63(4): 623-633, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31282455

RESUMO

BACKGROUND: The Ottawa Paramedic Physical Ability Test (OPPAT™) is a physical employment standard for the paramedic sector. If a candidate is unsuccessful in meeting the OPPAT™ performance standard they should be provided with an appropriate accommodation, such as a strength and conditioning program, to improve performance. OBJECTIVE: Develop, implement and evaluate the effectiveness of a 4-week strength and conditioning program on improving OPPAT™ performance and associated fitness measures in paramedic candidates. METHODS: A 4-week strength and conditioning program was developed to focus on strength and power improvements. Based on initial OPPAT™ performance, participants were divided into high and low performing groups; only the low performing group received the training intervention. OPPAT™ completion times and relevant fitness measures were compared pre- to post- intervention and between groups. RESULTS: Over the 4-weeks, peak lower body power and grip strength did not significantly improve in the intervention group, however OPPAT™ performance improved by 10%. The control group had significantly lower OPPAT™ completion times both pre- and post-intervention (19% and 11% lower respectively), as well as greater grip strength and peak lower body power. CONCLUSIONS: Implementation of a targeted strength and conditioning program successfully improved OPPAT™ performance in low performing candidates.


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Avaliação de Desempenho Profissional/estatística & dados numéricos , Exame Físico/estatística & dados numéricos , Aptidão Física , Treinamento de Resistência/métodos , Adulto , Pessoal Técnico de Saúde/normas , Avaliação de Desempenho Profissional/normas , Emprego/normas , Feminino , Humanos , Masculino , Ontário , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Adulto Jovem
6.
Work ; 63(4): 615-622, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31282456

RESUMO

BACKGROUND: The general physical task demands of law enforcement may suggest that police Officers are of similar fitness levels across cities, states and countries. OBJECTIVE: To investigate whether fitness levels of police Officers from two different United States (U.S.) Law Enforcement Agencies (LEA) are similar. METHODS: Retrospective data were analysed from two LEAs (LEA1 n = 79 and LEA2 n = 319). The data for Officers included: age, mass, 1-minute push-up repetitions, 1-minute sit-up repetitions, vertical jump height, 2.4 km run time (LEA 1) and 20-meter Multi-Stage Fitness Test results (LEA 2). Independent samples t-tests were used to compare anthropometric and fitness data between LEA with significance set at 0.05. RESULTS: Officers from LEA1 weighed significantly less and performed significantly better than Officers from LEA2 on all fitness measures. When comparing male Officers alone, there was no statistical difference in age and mass; nonetheless, Officers from LEA1 significantly outperformed Officers from LEA2 on all fitness measures. CONCLUSION: While similarities / differences in job tasks performed between these two LEA are not known, the results from this study suggest differences in fitness between these two different U.S. LEA. Fitness standards and training protocols need to be developed and contextualized to each LEA's specific population and needs.


Assuntos
Avaliação de Desempenho Profissional/estatística & dados numéricos , Teste de Esforço/estatística & dados numéricos , Aplicação da Lei , Aptidão Física/fisiologia , Polícia/estatística & dados numéricos , Adulto , Fatores Etários , Avaliação de Desempenho Profissional/normas , Treino Aeróbico , Teste de Esforço/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resistência Física/fisiologia , Polícia/normas , Estudos Retrospectivos , Fatores Sexuais , Estados Unidos , Adulto Jovem
7.
Work ; 63(4): 603-613, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31282457

RESUMO

BACKGROUND: Physical employment standards (PES) ensure that candidates can demonstrate the physical capacity required to perform duties of work. However, movement competency, or an individual's movement strategy, can relate to injury risk and safety, and therefore should be considered in PES. OBJECTIVE: Demonstrate the utility of using artificial intelligence (AI) to detect risk-potential of different movement strategies within PES. METHODS: Biomechanical analysis was used to calculate peak flexion angles and peak extensor moment about the lumbar spine during participants' performance of a backboard lifting task. Lifts performed with relatively lower and higher exposure to postural and moment loading on the spine were characterized as "low" or "high" exposure, respectively. An AI model including principal component and linear discriminant analyses was then trained to detect and classify backboard lifts as "low" or "high". RESULTS: The AI model accurately classified over 85% of lifts as "low" or "high" exposure using only motion data as an input. CONCLUSIONS: This proof-of-principle demonstrates that movement competency can be assessed in PES using AI. Similar classification approaches could be used to improve the utility of PES as a musculoskeletal disorders (MSD) prevention tool by proactively identifying candidates at higher risk of MSD based on movement competency.


Assuntos
Emprego/normas , Movimento/fisiologia , Traumatismos Ocupacionais/prevenção & controle , Exame Físico/métodos , Aptidão Física/fisiologia , Adulto , Pessoal Técnico de Saúde/normas , Inteligência Artificial , Fenômenos Biomecânicos/fisiologia , Avaliação de Desempenho Profissional/métodos , Avaliação de Desempenho Profissional/normas , Estudos de Viabilidade , Feminino , Humanos , Vértebras Lombares/fisiologia , Masculino , Exame Físico/normas , Estudo de Prova de Conceito , Amplitude de Movimento Articular/fisiologia , Medição de Risco/métodos , Adulto Jovem
8.
Work ; 63(4): 591-601, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31282458

RESUMO

BACKGROUND: Hesitation to employ females for physically demanding jobs is often due to sex related physical abilities. A physical employment standard (PES) identifies individuals who are physically capable for work. OBJECTIVE: A database containing 300 + sources of physical performance tests (PFTs) will inform potential sex bias for PES development. METHODS: Weighted means and probability density curves illustrate the percentage overlap between male and female performance on PFT data from the armed forces of 11 countries and the open literature. Where female training data were available, the change in percentage overlap illustrates the potential for reduction in sex-related differences. RESULTS: PFTs demonstrating the extremes of sex disparity were bench press (11 sources) and sit-ups (14 sources) with 9% and 93% overlap in performance, respectively. Training for bench press; pull ups; VO2max; and upright pull improved female performance by 12%, 22%, 35%, and 23% respectively. This translated into narrowing the gap between male and female mean performance by 1%, 4%, 5%, and 10% respectively. CONCLUSIONS: The ability of PFT to predict performance is essential; however, PFTs with more overlap will facilitate development of PES with reduced sex bias. PFTs with the greatest potential for improvement in females are identified here.


Assuntos
Bases de Dados Factuais , Avaliação de Desempenho Profissional/normas , Emprego/normas , Disparidades nos Níveis de Saúde , Sexismo/prevenção & controle , Avaliação de Desempenho Profissional/estatística & dados numéricos , Teste de Esforço/normas , Teste de Esforço/estatística & dados numéricos , Feminino , Humanos , Masculino , Militares , Condicionamento Físico Humano/fisiologia , Condicionamento Físico Humano/estatística & dados numéricos , Exame Físico/normas , Exame Físico/estatística & dados numéricos , Aptidão Física/fisiologia , Fatores Sexuais
9.
Work ; 63(4): 581-589, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31282459

RESUMO

BACKGROUND: To assess the post-implementation impact of the Canadian Type 1 Wildland Fire Fighter (WFF) Fitness Test Circuit (WFX-FIT), a retrospective descriptive analysis of anonymized aggregate data collected between 2012-2016 was conducted. OBJECTIVES: The objectives were to examine the pass rates of Type 1 WFF in each fire jurisdiction and on the standard for exchanging Type 1 WFF between agencies, the interagency exchange standard, by age group and sex and to propose what other information could be of value in assessing the effectiveness of implementing a physical employment standard. METHODS: Frequencies and pass rate percentages were compared by sex and age groups (<40 years, ≥40 years). RESULTS: Between 2012-2016, pass rates for all participants on the jurisdictional and interagency exchange performance standards improved from 93.2% to 95.6% and 79.1% to 87.6%, respectively. CONCLUSIONS: We conclude that since the WFX-FIT was implemented, there has been an increase in the number of exchange-eligible Type 1 WFF for suppression of wildfires in Canada.


Assuntos
Avaliação de Desempenho Profissional/estatística & dados numéricos , Emprego/normas , Bombeiros/estatística & dados numéricos , Exame Físico/estatística & dados numéricos , Aptidão Física , Adulto , Fatores Etários , Canadá , Avaliação de Desempenho Profissional/normas , Emprego/estatística & dados numéricos , Feminino , Humanos , Masculino , Exame Físico/normas , Estudos Retrospectivos , Fatores Sexuais , Incêndios Florestais
10.
Work ; 63(4): 571-579, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31282460

RESUMO

BACKGROUND: Beginning in 2017, successfully passing the four-part pre-enlistment Occupational Physical Assessment Test (OPAT) became a requirement for all U.S. Army recruits. To ensure the test accurately identifies individuals who are qualified for their job, it was necessary to examine classification errors. OBJECTIVE: The objectives were to 1) determine the accuracy of OPAT cut-scores for combat arms Soldiers, and 2) determine which events contribute to the individuals that are misclassified as passing or failing the OPATMETHODS:A total of 741 trainees were tested on the OPAT within two weeks of entering their initial entry training. At the end of their training, trainees were tested on simulations of the most physically demanding tasks of their job. RESULTS: There was a high classification concordance (76.5%) between success on the OPAT and job task simulations. False positives (6.7%) were misclassified because they did not perform as well on the strength-dominant task simulations. While the interval aerobic run was the greatest contributor to false negatives (16.8%), previous studies indicated high performance on this event as a potential key indicator of injury and attrition risk. CONCLUSIONS: The findings provide insight on how the accuracy of the OPAT, and similar pre-employment tests, could be improved.


Assuntos
Avaliação de Desempenho Profissional/métodos , Militares , Exame Físico/métodos , Aptidão Física , Adolescente , Avaliação de Desempenho Profissional/normas , Reações Falso-Negativas , Reações Falso-Positivas , Estudos de Viabilidade , Feminino , Humanos , Masculino , Exame Físico/normas , Valor Preditivo dos Testes , Estados Unidos , Guerra , Adulto Jovem
11.
Work ; 63(4): 559-569, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31282461

RESUMO

BACKGROUND: Given the physical demands of mining and rescue operations, a physical employment standard was warranted to ensure capable workers are selected. While evaluations of muscular strength and muscular and cardiorespiratory endurance domains are common, assessment of a worker's ability to meet the physically demanding postural requirements is often neglected. OBJECTIVE: The aim of this investigation was to develop a valid assessment for NSW Mines Rescue Brigadesmen that replicated the combined muscular and cardiorespiratory endurance and postural demands of constructing a timber pillar. METHODS: Oxygen consumption () V̇O2) was measured and dominant postures identified when incumbent Brigadesmen constructed a timber pillar. A shelf-stacking assessment was designed and validated. RESULTS: When Brigadesmen performed the block placement role, the task elicited a mean V̇O2 of 1.6 L.min-1, and required repeated placement of ∼8.7 kg blocks from 0 to 3.0 m. A shelf stacking assessment (5 min, mean V̇O2 1.7 L.min-1) replicating dominant postures and requiring repeated block placement at 0, 0.65, 1.10, 1.64 and 2.20 m was developed. The demand of the test, performed within a discontinuous circuit, was subsequently verified (1.6 L.min-1). CONCLUSIONS: A valid, physiological aptitude test that considered the job-related movement patterns, in addition to cardiorespiratory and muscular endurance requirements, was developed for Brigadesmen.


Assuntos
Avaliação de Desempenho Profissional/métodos , Emprego/normas , Exame Físico/métodos , Aptidão Física/fisiologia , Trabalho de Resgate/normas , Adulto , Aptidão/fisiologia , Avaliação de Desempenho Profissional/normas , Humanos , Masculino , Pessoa de Meia-Idade , Mineração , Força Muscular , New South Wales , Consumo de Oxigênio , Exame Físico/normas
12.
Work ; 63(4): 547-557, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31282462

RESUMO

BACKGROUND: The National Ambulance Resilience Unit (NARU) works on behalf of each National Health Service (NHS) Ambulance Trust in England to strengthen national resilience and improve patient outcome in challenging pre-hospital scenarios. OBJECTIVE: To conduct a Job Task Analysis and describe the physical demands of NARU roles. METHODS: A focus group was conducted to describe the physically demanding tasks performed by NARU personnel. Subsequently, the physical demands of the identified tasks were measured in 34 NARU personnel (29 male and 5 female). RESULTS: Eleven criterion tasks were identified; Swift Water Rescue (SWR), Re-board Inflatable Boat (RBIB), Set up Decontamination Tent (SDT), Clinical Decontamination (CD), Movement in Gas Tight Suits (MGTS), Marauding Terrorist Fire Arms (MTFA), Over Ground Rescue (OGR), Unload Incidence Response Unit Vehicle (UIRUV), Above Ground Rescue (AGR), Over Rubble Rescue (ORR) and Subterranean Rescue (SR). The greatest cardiovascular strain was measured during SWR, MGTS, and MTFA. The most thermally challenging tasks were the MTFA, CD, SR and OGR. The greatest muscular strength requirements were during MTFA and OGR. CONCLUSIONS: All five components of fitness (aerobic endurance, anaerobic endurance, muscular strength, muscular endurance and mobility) were required for successful completion of the physically demanding tasks performed by NARU personnel.


Assuntos
Ambulâncias/normas , Auxiliares de Emergência/normas , Avaliação de Desempenho Profissional/normas , Aptidão Física , Análise e Desempenho de Tarefas , Ambulâncias/organização & administração , Inglaterra , Feminino , Grupos Focais , Humanos , Masculino , Seleção de Pessoal/normas , Melhoria de Qualidade , Medicina Estatal/organização & administração , Medicina Estatal/normas
13.
Work ; 63(4): 537-545, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31282463

RESUMO

BACKGROUND: To establish whether an organization has a valid Physical Employment Standard (PES), it is important to determine those aspects of the job that are critical to operational success. OBJECTIVE: To determine the tasks of the Offshore Wind Industry (OWI) and whether the ability to undertake these tasks is adequately assessed. METHODS: The task analysis was completed through: observations; the research team undertaking tasks; reviewing operational manuals; and focus groups. In addition, a review of existing PES for the OWI was completed to determine whether standards matched with the results of the task analysis. RESULTS: Five critical tasks were identified: transfer from the vessel to the Transition Piece; ascent of the internal ladder; manoeuvre through hatches; torque and tensioning; and hauling a casualty up the tower. With the exception of aerobic capacity, the physical components required by Technicians are not assessed by the current medical standards, nor are these assessments standardized across companies. CONCLUSIONS: The Job Task Analysis undertaken can be used to inform decisions regarding the physical fitness requirements (selection), assessments and training of Technicians, with a view to ensuring that they are physically capable of undertaking the critical tasks without undue risk of injury to themselves or others.


Assuntos
Avaliação de Desempenho Profissional/normas , Emprego/normas , Seleção de Pessoal/normas , Análise e Desempenho de Tarefas , Vento , Adulto , Tomada de Decisões Gerenciais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aptidão Física , Centrais Elétricas , Navios , Reino Unido , Local de Trabalho , Adulto Jovem
14.
Med Educ Online ; 24(1): 1635844, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31246539

RESUMO

Periodic review of resident performance is an important aspect of residency training. Amongst allopathic residency programs, it is expected that the performance of resident physicians which can be grouped based on the ACGME core competencies, be assessed so as to allow for effective feedback and continuous improvement. Review of monthly evaluation forms for residents in the core ACGME programs at Marshall University and the University of Toledo demonstrated a wide spread in the number of Likert questions that faculty were asked to complete. This number ranged from a low of 7 in Surgery to a high of 65 in Psychiatry (both Marshall Programs). Correlation and network analysis were performed on these data. High degrees of correlations were noted between answers to questions (controlled for each resident) on these forms at both institutions. In other words, although evaluation scores varied tremendously amongst the different residents in all the programs studied, scores addressing different competencies tended to be very similar for the same resident, especially in some of the programs which were studied. Network analysis suggested that there were clusters of questions that produced essentially the same answer for a given resident, and these clusters were bigger in some of the different residency program assessment forms. This seemed to be more the rule in the residency programs with large numbers of Likert questions. The authors suggest that reducing the number of monthly questions used to address the core competencies in some programs may be possible without substantial loss of information.


Assuntos
Avaliação de Desempenho Profissional/organização & administração , Internato e Residência/organização & administração , Competência Clínica , Coleta de Dados , Avaliação de Desempenho Profissional/normas , Humanos , Internato e Residência/normas , Avaliação de Programas e Projetos de Saúde
15.
Work ; 63(4): 521-536, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31033477

RESUMO

BACKGROUND: The roles of the emergency services are challenging and often physically demanding. Readiness to meet these challenges and demands is a fundamental requirement for staff to deliver their roles safely and effectively. Furthermore, employers are required by law to demonstrate every reasonable effort to protect their staff from undue risk of work-related injury. Implementing Physical Employment Standards (PES) enables employers to assign staff to roles for which they are physically-suited whilst contributing to such duty-of-care. However, for PES to be successful and legally-defendable, standards must reflect the demands of those job-tasks which are truly critical to the readiness of these services. OBJECTIVE: To determine whether a standardised approach to identifying critical job-tasks exists in the development of PES for the emergency services. METHODS: Studies which conducted analysis of job-tasks to develop PES within the emergency services were reviewed. RESULTS: Forty-two reported studies (i.e. records) met the inclusion criteria. Methods to determine job-tasks varied but were typically criteria-based incorporating one, or all, of 9 reported techniques. Methods were subjective and based upon reference to past or present job-task performance. CONCLUSION: Correctly determining critical job-tasks is essential for effective, legally-defendable PES. A standardised method to define job-tasks remains to be established.


Assuntos
Socorristas , Avaliação de Desempenho Profissional/normas , Emprego/normas , Exame Físico/normas , Desempenho Profissional/normas , Avaliação de Desempenho Profissional/legislação & jurisprudência , Emprego/legislação & jurisprudência , Humanos , Traumatismos Ocupacionais/prevenção & controle , Seleção de Pessoal/legislação & jurisprudência , Seleção de Pessoal/normas , Aptidão Física , Políticas , Carga de Trabalho
16.
Br J Gen Pract ; 69(681): e287-e293, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30803979

RESUMO

BACKGROUND: Tests of competence are written and clinical assessments taken by doctors under investigation by the General Medical Council (GMC) who have significant performance concerns. Male doctors on average perform more poorly in clinical assessments than female doctors, and are more likely to be sanctioned. It is unclear why. AIM: To examine sex differences in the tests of competence assessment scores of GPs under investigation by the GMC, compared with GPs not under investigation, and whether scores mediate any relationship between sex and sanction likelihood. DESIGN AND SETTING: Retrospective cohort study of GPs' administrative tests of competence data. METHOD: Analysis of variance was undertaken to compare written and clinical tests of competence performance by sex and GP group (under investigation versus volunteers). Path analysis was conducted to explore the relationship between sex, written and clinical tests of competence performance, and investigation outcome. RESULTS: On the written test, female GPs under investigation outperformed male GPs under investigation (Cohen's d = 0.28, P = 0.01); there was no sex difference in the volunteer group (Cohen's d = 0.02, P = 0.93). On the clinical assessment, female GPs outperformed male GPs in both groups (Cohen's d = 0.61, P<0.0001). A higher clinical score predicted remaining on the UK medical register without a warning or sanction, with no independent effect of sex controlling for assessment performance. CONCLUSION: Female GPs outperform male GPs on clinical assessments, even among GPs with generally very poor performance. Male GPs under investigation may have particularly poor knowledge. Further research is required to understand potential sex differences in doctors who take tests of competence and how these impact on sex differences in investigation outcomes.


Assuntos
Competência Clínica , Avaliação Educacional , Avaliação de Desempenho Profissional , Clínicos Gerais , Adulto , Competência Clínica/legislação & jurisprudência , Competência Clínica/normas , Avaliação Educacional/métodos , Avaliação Educacional/estatística & dados numéricos , Avaliação de Desempenho Profissional/métodos , Avaliação de Desempenho Profissional/normas , Avaliação de Desempenho Profissional/estatística & dados numéricos , Feminino , Clínicos Gerais/legislação & jurisprudência , Clínicos Gerais/normas , Humanos , Londres , Masculino , Melhoria de Qualidade/organização & administração , Fatores Sexuais , Desempenho Profissional
17.
J Clin Nurs ; 28(9-10): 1528-1537, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30588721

RESUMO

AIMS AND OBJECTIVES: To explore staff nurses' discourses of workplace bullying, to critically examine how these discourses affect their responses to bullying. BACKGROUND: Workplace bullying has been identified as a pervasive problem within the nursing profession. Efforts to eradicate workplace bullying need to involve staff-targets as well as bystanders. By understanding how this population conceptualises workplace bullying, more effective and targeted solutions to the problem can be devised. DESIGN: This qualitative study used a critical discourse analysis method which was based on the work of Foucault. METHODS: Thirteen staff nurses who worked in a variety of settings in the USA were interviewed. COREQ checklist was used for this article. RESULTS: Three interrelated discursive strands were identified: "biased behaviour manifested as workplace bullying, workplace bullying disguised as performance review and workplace bullying as entrenched behaviour in nursing". Actions in response to bullying varied according to which discursive strand was invoked. CONCLUSIONS: The central theme at the intersection of the discursive strands was that workplace bullying is a mechanism for driving out nurses who are different. RELEVANCE TO CLINICAL PRACTICE: Efforts to address workplace bullying among nurses need to include training on legitimate methods of performance review, workshops on how to interact with diverse co-workers, and examination of how practices with nursing education contribute to the perpetuation of bullying in clinical settings.


Assuntos
Bullying/psicologia , Bullying/estatística & dados numéricos , Avaliação de Desempenho Profissional/normas , Recursos Humanos de Enfermagem no Hospital/normas , Local de Trabalho/psicologia , Local de Trabalho/normas , Adulto , Idoso , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Washington
18.
Cad Saude Publica ; 34(11): e00013918, 2018 11 08.
Artigo em Inglês | MEDLINE | ID: mdl-30427408

RESUMO

Brazilian educational guidelines reinforce patient-centered care communication skills as an important competence for medical students. The Four Habits Coding Scheme (4HCS) is an instrument used for teaching and assessing clinicians' communication skills in a person-centered care approach. We aimed to translate and culturally adapt the 4HCS into Brazilian Portuguese. The translation process was accomplished in seven stages: initial translation, reconciliation, back translation, review by the author, independent review, consensus version through Delphi technique, review by a language coordinator, and pretest. During pretest, three independent observers assessed four medical consultations, which were performed by medical students and residents, that had been recorded in a real healthcare scenario. Reviewers had difficulty in reaching consensus on expressions referring to understanding the person as a whole, such as "Engage in small talk", "Expansion of concerns", "Elicit full agenda", "Use patient's frame of reference", and "Explore plan acceptability". They also had difficulty in reaching consensus on the translation of the word "clinician", which was first translated as "physician". Historical and cultural issues in the physician-patient relationship may have influenced this result. The Brazilian 4HCS is a culturally, conceptually, semantically and operationally sound instrument. It may represent an important advance for strengthening the person-centered care model in Brazil.


Assuntos
Comunicação , Comparação Transcultural , Educação Médica/métodos , Avaliação Educacional/métodos , Avaliação de Desempenho Profissional/métodos , Inquéritos e Questionários , Traduções , Brasil , Avaliação de Desempenho Profissional/normas , Humanos , Relações Médico-Paciente , Competência Profissional/normas , Semântica
19.
Crit Care Med ; 46(12): 1898-1905, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30247242

RESUMO

OBJECTIVE: Measuring teamwork is essential in critical care, but limited observational measurement systems exist for this environment. The objective of this study was to evaluate the reliability and validity of a behavioral marker system for measuring teamwork in ICUs. DESIGN: Instances of teamwork were observed by two raters for three tasks: multidisciplinary rounds, nurse-to-nurse handoffs, and retrospective videos of medical students and instructors performing simulated codes. Intraclass correlation coefficients were calculated to assess interrater reliability. Generalizability theory was applied to estimate systematic sources of variance for the three observed team tasks that were associated with instances of teamwork, rater effects, competency effects, and task effects. SETTING: A 15-bed surgical ICU at a large academic hospital. SUBJECTS: One hundred thirty-eight instances of teamwork were observed. Specifically, we observed 88 multidisciplinary rounds, 25 nurse-to-nurse handoffs, and 25 simulated code exercises. INTERVENTIONS: No intervention was conducted for this study. MEASUREMENTS AND MAIN RESULTS: Rater reliability for each overall task ranged from good to excellent correlation (intraclass correlation coefficient, 0.64-0.81), although there were seven cases where reliability was fair and one case where it was poor for specific competencies. Findings from generalizability studies provided evidence that the marker system dependably distinguished among teamwork competencies, providing evidence of construct validity. CONCLUSIONS: Teamwork in critical care is complex, thereby complicating the judgment of behaviors. The marker system exhibited great potential for differentiating competencies, but findings also revealed that more context specific guidance may be needed to improve rater reliability.


Assuntos
Avaliação de Desempenho Profissional/organização & administração , Unidades de Terapia Intensiva/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Centros Médicos Acadêmicos/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Competência Clínica/normas , Comunicação , Avaliação de Desempenho Profissional/normas , Feminino , Processos Grupais , Humanos , Unidades de Terapia Intensiva/normas , Liderança , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/normas , Transferência da Responsabilidade pelo Paciente/normas , Reprodutibilidade dos Testes , Estudos Retrospectivos , Visitas com Preceptor/normas , Gravação de Videoteipe
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